Interview with Sex Therapist Dr. Rose Hartzell (Part 2)

There was just so much great content from my interview with Dr. Rose Hartzell, PhD, EdS, CHES, LMFT, Sex Therapist at San Diego Sexual Medicine. I had to break it up so you could take it all in. Here is part 2!

6.  In your experience, what have you seen to be the most common difficulty or challenge that couples face when one partner suffers from painful sex?

My honest answer of what I have seen across the board as the most common difficulty is acceptance that other sexual activities are sex.  If a woman has pain, often it is the woman that has the hardest time with this.  Exploring ways to bring pleasure to each other can be a fun experience for couples and is not so emotionally charged.  Often women will say that if I can’t have intercourse, why even bother.  And sex becomes about performance or reaching a goal.  But, I hear a lot of the men say, “I will take anything, I would be happy with oral sex or I can masturbate, I just want to be close to my partner again.  I just want her to touch me.”  Not every man is the same, but in general that is what I have noticed.

7.  Does your answer to the previous question change depending on whether the partner suffering from pain is male or female, and if so, how?

We also do see a lot of men with pain, but I feel like most women we see have vestibulodynia.  It’s not the same case over and over again, but it is a really similar presentation and similar symptoms.  The women with pain are often a Type A personality, will have gastrointestinal issues, and are very anxious.  Everyone is different but in general there is a common type.

For men with pain, there isn’t really as much of a pattern to it, at least in my experience here (at San Diego Sexual Medicine).  They come from really random different issues that cause pain.  But with men with pain it doesn’t necessarily seem to affect their sexual relationship as much.  Either they are in so much pain that they don’t want to have sex at all, and usually their partner is okay with that and it’s not causing issues, or they are just working around it.  It also doesn’t seem to have as much psychosocial ramifications as it does with women.

8.  In your experience, what is something that the suffering partner does not typically realize about what the other is dealing with?

A pattern I often see is because the suffering person thinks that if they are physically affectionate in certain ways it’s going to lead to sex.  So they have kind of stopped physical affection because they don’t want to give their partner the wrong idea.  And so oftentimes the partner is really missing that.  Another thing is the other partner often feels guilt as well that they have their sexual needs, that they are a sexual person. They feel bad for their partner but also feel bad that they have their own needs as well and are sometimes afraid to ask for them or to say “hey, can we try to work around this.”

What about the other way, what is something the partner who is not suffering often doesn’t realize that the suffering partner is dealing with?

I don’t know if they don’t realize it, but I think it’s hard to understand, when you’re the suffering person it’s your body and as much as you want to change it there is really nothing you can do and just the frustration that the suffering person is feeling.  They can’t completely understand it because it’s not their body.

9.  What are some specific steps couples can take to help minimize these difficulties in their relationship?

To maintain a sexual relationship, whatever that might be.  To maintain a physical relationship, but to do so in a way that there is no pain and that both voices are heard and that it feels very consensual.  Oftentimes here at San Diego Sexual Medicine when people will originally come here we always like to take intercourse off the table so that the suffering person doesn’t have to worry about experiencing pain.  And then trying to find ways that they can experience pleasure with their partner without pain and whatever that might be.  For some people they have pain even during arousal, for some people it’s only if something is inserted.  It’s different for everyone but trying to find ways for them to still have a sexual relationship without having pain.

For more information about Dr. Hartzell and San Diego Sexual Medicine, check out their website You can also contact the center directly at (619) 265-8865. People travel to San Diego Sexual Medicine from all over the world to receive treatment for their sexual health concerns. You can also learn more about Dr. Hartzell on her website

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